POS0681 DRUG RETENTION RATE AND EFFECTIVENESS OF JAK INHIBITOR IN PATIENTS WITH DIFFICULT-TO-TREAT RHEUMATOID ARTHRITIS
Authors: S. Anno, T. Okano, K. Mandai, K. Orita, Y. Yamada, K. Mamoto, T. Iida, M. Tada, K. Inui, T. Koike, H. Nakamura
Journal: Annals of the Rheumatic Diseases (2022)

Background Recently, the disease activity of rheumatoid arthritis (RA) was improved due to the ‘treat-to-target’ strategy. However, some patients remain various symptoms despite recommended treatment was performed. Then, the term of ‘difficult-to-treat RA (D2TRA)’ is widely recognized. Janus kinase inhibitor (JAKi) might be effective for D2TRA patients, because JAKi can simultaneously block the function of multiple cytokines. Objectives The aim of this study was to evaluate drug retention rate and effectiveness of JAKi in patients with D2TRA. Methods This study included 220 RA patients (tofacitinib 101, baricitinib 83, upadacitinib 20, peficitinib 14, filgotinib 2) treated with JAKi. Sixty-two patients were treated as first line bDMARDs/JAKi (1st group), 57 patients were treated as second line bDMARDs/ JAKi (2nd group), 101 patients were treated as third and more bDMARDs/ JAKi. In these 101 patients, 25 patients did not met D2TRA criteria (non-D2TRA group) and 76 patients met D2TRA criteria (D2TRA group). Drug retention rate and effectiveness of JAKi were evaluated during 24 weeks in each group. Results Usage rate of methotrexate was lower and dosage of glucocorticoid was higher in D2TRA group than in other groups (Table 1). Drug retention rate at 24 weeks was 87.1% (54/62) in 1st group, 80.1% (46/57) in 2nd group, 88% (22/25) in non-D2TRA group, 61.8% (47/76) in D2TRA group. Drug retention rate was lower in D2TRA group compared to 1st group, 2nd group and non-DT2RA group (p&lt;0.01, p=0.03, p=0.01). DAS28-CRP was 4.4, 4.0, 3.9, 4.4 at baseline, 3.0, 3.0, 3.3, 3.5 at 4 weeks, 2.5, 2.9, 2.7, 3.3 at 12 weeks, 2.5, 3.0, 2.9, 3.2 at 24 weeks in 1st group, 2nd group, non-D2TRA group and D2TRA group, respectively. Improvement ratio of DAS28-CRP was 32.9, 27.6, 20.4, 19.3 % at 4 weeks, 40.8, 26.5, 28.1, 19.5 % at 12 weeks, 40.8, 24.6, 18.7, 24.7 % at 24 weeks. DAS28-CRP was improved in all groups. Altough 1st group showed higher improvement ratio of DAS28-CRP at 24 weeks compared to 2nd group, non-DT2RA group and D2TRA group (p&lt;0.01, p&lt;0.01, p&lt;0.01), there was no differences between DT2RA group and 2nd group or non-D2TRA group (p=0.95, p=0.48). SDAI was 22.9, 19.9, 18.3, 23.9 at baseline, 11.8, 11.9, 13.3, 14.4 at 4 weeks, 7.9, 11.3, 8.4, 13.3 at 12 weeks, 8.5, 11.5, 9.7, 12.6 at 24 weeks. CDAI was 21.3, 18.8, 17.6, 21.8 at baseline, 11.3, 11.2, 12.5, 13.9 at 4 weeks, 7.5, 10.9, 8.0, 12.3 at 12 weeks, 8.1, 10.7, 8.6, 12.1 at 24 weeks. HAQ was 1.15, 0.99, 0.89, 1.39 at baseline, 0.84, 0.76, 0.93, 1.22 at 4 weeks, 0.79, 0.84, 0.77, 1.17 at 12 weeks, 0.76, 0.79, 0.76, 1.14 at 24 weeks. Improvement rate of HAQ at 24 weeks were 44.3%, 23.9%, 21.2%, 8.1%. Table 1. Baseline characteristics of RA patients 1st group (n=62) 2nd group (n=57) non-D2TRA group (n=25) D2TRA group (n=76) Age (years) 64.9 ± 14.8 66.1 ± 11.5 64.6 ± 16.1 63.0 ± 15.0 Female (%) 75.8 79.0 96.0 80.3 Disease durations (years) 10.4 ± 11.7 17.6 ± 17.6 22.6 ± 22.4 16.3 ± 15.7 RF (IU/ml) 296.3 ± 1153.8 314.9 ± 1037.7 262.4 ± 375.9 305.9 ± 819.6 RF positive ratio (%) 81.8 78.4 79.2 75.7 Anti CCP antibody (U/ml) 221.8 ± 327.2 157.8 ± 258.7 95.9 ± 101.6 191.8 ± 250.6 Anti CCP antibody positive ratio (%) 79.6 79.6 72.2 83.3 CRP (U/ml) 1.5 ± 2.1 1.1 ± 2.0 1.6 ± 1.6 1.8 ± 2.9 MMP-3 (ng/ml) 185.7 ± 167.6 146.7 ± 122.1 190.1 ± 152.6 268.0 ± 451.2 DAS28-CRP 4.3 ± 1.2 4.1 ± 1.3 3.9 ± 1.4 4.4 ± 1.3 SDAI 21.8 ± 12.2 21.7 ± 13.1 18.4 ± 13.0 23.9 ± 12.8 CDAI 20.3 ± 11.3 20.7 ± 12.7 17.6 ± 12.8 22.1 ± 12.2 HAQ 1.1 ± 0.8 1.2 ± 1.0 0.9 ± 0.8 1.4 ± 1.1 MTX use (%) 69.4 63.2 56 47.4 MTX (mg/day) 10.7 ± 3.4 10.4 ± 3.5 8.8 ± 3.5 9.0 ± 4.3 Glucocorticoid use (%) 29.1 36.8 16 46.1 Glucocorticoid dose (mg/day) 3.3 ± 2.1 3.0 ± 1.5 3.5 ± 1.9 5.1 ± 2.8 Conclusion Drug retention rate of JAKi in treatment of D2TRA group were lower than that of 1st group, 2nd group, and non-D2TRA group. Clinical efficacy of JAKi in D2TRA group were not significantly different to 2nd group and non-D2TRA group. However, HAQ improvement was weak in D2TRA group. Disclosure of Interests None declared